688 NE 101 St (11)BUILDING INSPECTION DEPARTMENT •
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the i3uilding Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
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Street,4(-
Registered Architect and/or Engineer ,:a."2.k74.
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Name and address of licensed contractor
Owner's Name and Address97i . id -
Chairman
Member
Member
Council Approved
r-r-- 4 te .
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Building Inspector
NOTE: A chdrge of $1.00 will be made for
the Planning Board.
A re-inspection fce of $1.00 will be charged
materials and/or workmanship.
MIAMI SHORES VILLAGE
4.
Location and legal description of lot to be built on:
Lot Block 4 Subdivision
Date
Date Disapproved.
Amount of Permit $,.
_Plan Cubage
Size of Building Lot
Street and Number where work is to be done
State work to be done and purpose of building (by floors) 11
( c r! L A ) c "■
and for no other purpose.
Remodeling New Building .-----
g Addition 'Repairs No. of Stories 67 " 7 1-e.
To be constructed of Kind of foundation Roof Covering ---- yt. La .1 :,.1
1
Estimated Total cost of improvements $ 42
Zone cubage required
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement.
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su tractors, o ork to be performed under this
pennit, as are licensed by Miami Shores Village.
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Remarks. (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, persortally ap-
peared .—
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
making corrections or changes to this application after approval has
when such re-inspection is made necessary by improper notice for
...
My Commission Expires
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true
Permit No....
Disapproved
(Signed)
PLANNING BOARD DATE
Member
Member
Member
me well known,
Date
been obtained from
inspection or faulty
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